Gynaecological laparoscopy deaths in Australia.

Epidemiological survey of chronic obstructive pulmonary disease and alpha-1-antitrypsin deficiency in Australia.

In their Seminar on type 2 diabetes, Ehtasham Ahmad and colleagues1Ahmad E Lim S Lamptey R Webb DR Davies MJ Type 2 diabetes.Lancet. 2022; 400: 1803-1820Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar highlighted the current and future global burden of disease and correctly stated that the increased risk of premature death from this chronic condition is mainly driven through the detrimental effects on vascular integrity. Accordingly, many national guidelines recommend secondary prevention of cardiovascular disease. We would like to draw attention to three studies from the past 10 years indicating that cancer is, or is predicted to become, the leading cause of diabetes-related death. An Australian study from 2014 reported on cause-specific mortality trends in over 1·1 million people with diabetes (1997–2010), and noted that cardiovascular disease was the most common contributor to death, but rates had declined.2Harding JL Shaw JE Peeters A Guiver T Davidson S Magliano DJ Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997–2010.Diabetes Care. 2014; 37: 2579-2586Crossref PubMed Scopus (105) Google Scholar By contrast, cancer deaths had increased, becoming the second most common cause of death in Australia. In 2021, Pearson-Stuttard and colleagues3Pearson-Stuttard J Bennett J Cheng YJ et al.Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care records.Lancet Diabetes Endocrinol. 2021; 9: 165-173Summary Full Text Full Text PDF PubMed Scopus (92) Google Scholar evaluated causes of death trends in over 300 000 individuals with diabetes in England (2001–18). They concluded that “the decline in vascular death rates has been accompanied by….a transition…to cancers as the leading contributor to diabetes-related death”. Similarly, mortality trends in Swedish National Diabetes Registry data predict that cancer will be the leading cause of death among individuals with diabetes by 2030.4Bjornsdottir HH Rawshani A Rawshani A et al.A national observation study of cancer incidence and mortality risks in type 2 diabetes compared to the background population over time.Sci Rep. 2020; 1017376 Crossref Scopus (24) Google Scholar This changeover reflects declining cardiovascular disease mortality through improved prevention, coupled with increasing cancer-related mortality, in part reflecting increased cancer incidence secondary to the survival advantage afforded through cardiovascular disease prevention. It is time to widen secondary prevention efforts in people with diabetes to reducing cancer incidence and, among those with diabetes who develop cancer, improving cancer survival, ultimately avoiding many premature deaths. We declare no competing interests. Type 2 diabetesType 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Full-Text PDF Cancer is becoming the leading cause of death in diabetes – Authors' replyWe thank Mengying Wang and colleagues for their very insightful comments on our Seminar on type 2 diabetes.1 They have drawn our attention to the fact that cancer is, or is predicted to become, the leading cause of diabetes-related death in the coming years, overtaking cardiovascular disease. We acknowledge that cancer rates are rising in people with type 2 diabetes. Indeed, in January, 2023, our team at Leicester Diabetes Research Centre published data demonstrating a transition from cardiovascular disease to cancer deaths in type 2 diabetes. Full-Text PDF

BACKGROUND AND AIMSSaudi Arabia has no precise data on causes of death. We sought to ascertain the commonest causes of death as stated in death certificates of adults and evaluate the completeness of death certificates at a teaching hospital in Riyadh.DESIGN AND SETTINGA cross-sectional study carried out at King Khalid University Hospital in Riyadh, Saudi Arabia, during the year 2008.METHODSAll death certificates that were issued in 2008 were reviewed and data were checked by two reviewers. Causes of death were coded according to specially-designed codes.RESULTSThe mean (SD) age of death was 63.9 (20.7) years. More than 80% arrived alive at the hospital. Among the 410 certificates, 62.2% had the first reported cause of death being classified as “inappropriate” and this tended to be slightly, but significantly more frequent among women. The first most common appropriately reported cause of death was malignancy of any type (7.3%) followed by ischemic heart diseases (4.9%). Accidents and fractures were more common in the younger age groups and among men.CONCLUSIONSThis is the first study that documents the possible gaps among healthcare professionals in Saudi Arabia in their understanding of death and its certification based on the clinical assessment of the deceased. The findings needs to be validated by similar studies from other health care sectors. It is clear, however, that proven educational, system-related and legal interventions to improve the accuracy of death certification are strongly needed if the health care priorities are to be properly identified.

Heart Disease and Pregnancy: The Need for a Twenty-First Century Approach to Care…

718 Cardiovascular Causes of Maternal Death in Australia - A Nationwide Autopsy Study

Travel‐weary to travel‐worry: the epidemiology of injury‐related traveller deaths in Australia, 2006‐2017

Maternal mortality: What can we learn from stories of postpartum haemorrhage?

Underlying causes of cocaine, amphetamine and opioid related deaths in Australia

Smoking is the single greatest preventable cause of premature death and disease in Australia.1 In 1998 approximately 19 000 deaths in Australia were attributable to the use of tobacco.2 Almost...

Lysergic acid diethylamide (LSD) and psilocybin are used as recreational drugs, and there is renewed interest in their clinical use. The current study aimed to (1) determine the circumstances of death and case characteristics of LSD- and psilocybin-related death in Australia, 2000-23; and (2) determine the toxicological profile and major autopsy findings of these cases. This was a retrospective exploratory study of all cases of LSD- and psilocybin-related death in Australia, 2000-23, retrieved from the National Coronial Information System. A total of 43 cases were identified: 33 LSD and 10 psilocybin. The median ages were 24 years [interquartile range (IQR) = 13, range = 16-53] (LSD) and 26 years (IQR = 18.5, range = 20-58) (psilocybin), and fewer than five cases were female. The most common circumstance of death among both groups was traumatic accident (LSD 36.4%, psilocybin 40.0%). There were 12 cases of self-harm, all of which involved LSD, all by physical means. In a fifth, death was attributed to multiple drug toxicity (LSD 18.2%, psilocybin 20.0%). In one case, death was attributed solely to LSD toxicity, while in a further two cases death was attributed to a cardiovascular event following LSD consumption (one LSD only, one multiple drug toxicity). In four psilocybin cases, the cause of death was undetermined. The most common clinical presentation was severe agitation (LSD 27.3%, psilocybin 20.0%). Median blood concentrations were LSD 0.8μg/l (IQR = 1.7, range = 0.1-3), psilocin 20 μg/l (IQR = 53.5, range = 6-83). LSD was the only drug present in 25.0% of LSD cases and psilocybin in 20.0% of psilocybin cases. Pre-existing organ pathology was uncommon. Lysergic acid diethylamide (LSD)- and psilocybin-related death in Australia from 2000 to 2023 was primarily due to traumatic injury, whether through accident or self-harm. Cases of acute toxic reactions that were attributed solely to LSD were rare.

Deaths in Australia and other high-income countries increasingly involve multiple conditions. However, key burden of disease measures typically only use the underlying cause of death (UC). We quantified sex and cause-specific years of life lost (YLL) based on UC compared with a method integrating multiple causes of death. Causes of death for all deaths in Australia (2015-17), mapped to 136 groups based on International Classification of Diseases 10th revision (ICD-10), were ascribed using (1) the UC only and (2) a multiple cause weighting (WT) strategy. Applying the Global Burden of Disease 2010 life table, YLLUC and YLLWT rates were calculated for each sex and cause of death and compared using relative and absolute measures. All-cause YLL rates were 113.4/1000 for males and 79.9/1000 for females. Cancers, cardiovascular diseases, external causes, respiratory diseases and nervous system diseases were the five biggest contributors to YLL for each method. For the top 20 causes combined, YLLWT rates were 10% lower for males (YLLWT = 74.93/1000 vs YLLUC = 67.38/1000) and 7% lower for females (YLLWT = 51.34/1000; YLLUC = 47.90/1000); YLLWT rates were lower for ischaemic heart disease and all cancers, but higher for diabetes and dementia, and for chronic obstructive pulmonary disease in males. With multiple cause weighting, renal failure emerged among the top 20 causes of YLL, as did atrial fibrillation and hypertension among females. YLLWT rates for substance abuse, mood disorders, hypertension and schizophrenia were relatively high compared with YLLUC. The YLLWT metric highlights epidemiologically important conditions that are less often selected as the UC.

The primary aim of the present study was to investigate Australian ED staff perspectives and needs regarding palliative care provision. Secondary aims were to assess staff views about death and dying, and their awareness of common causes of death in Australia, particularly those where a palliative care approach is appropriate. All medical and nursing staff working in a private ED in Perth, Western Australia, were asked to complete a combined quantitative and qualitative survey. The survey tool uses a combination of Likert-type scales and open-ended questions. Descriptive statistics and intergroup comparisons were made for all quantifiable variables, whereas formal content analysis was used for text responses. Surveys were returned by 22 doctors and 44 nurses, with most reporting only working knowledge of palliative care but clinical proficiency in symptom control. Confidence in palliative care provision was lower among nursing than medical staff but educational needs were similar. Cancer diagnoses were consistently overestimated, and dementia and COPD underestimated, as the most common causes of death. Only six of 63 (9.5%) of respondents identified the correct top five causes of death. Our study suggests that although ED staff expressed confidence regarding symptom management in palliative care, they lacked understanding of the patients in whom a palliative approach could be applied and sought further education in areas, such as end-of-life communication and ethical issues. ED specific training and clinical interventions in palliative care provision would seem to be needed and justified.

The number of meth/amphetamine related deaths in Australia has quadrupled in the last 20 years, primarily due to drug toxicity and suicide among individuals in their 30s and 40s. Previous analysis of Australian meth/amphetamine-related deaths covered limited timeframes and causes, and there has been no exploration of the effects of changing cohorts on meth/amphetamine mortality. This paper provides comprehensive insights across 20 years into the evolving cohort trends in meth/amphetamine-related deaths in Australia. An age-period-cohort-interaction (APC-I) analysis of Australian meth/amphetamine-related deaths (2001-2020) by cause extracted from the National Coronial Information System, a database of all deaths reported to the coroner in Australia and New Zealand. APC-I analyses revealed that unintentional drug toxicity deaths peaked at ages 35-38 [Coefficient (Coef) = 0.92; 95% confidence interval (CI) = 1.0-0.8], intentional self-harm deaths peaked at ages 31-34 (Coef = 1.2; 95% CI = 1.4-1.0), unintentional injury deaths peaked at ages 23-26 (Coef = 1.02; 95% CI = 1.2-0.8) and natural cause deaths at 39-42 (Coef = 1.15; 95% CI = 1.4-0.9). Period effects were consistent across all causes, with a mean 29.3% increase in estimated mortality rate from 2001 to 2012, followed by a mean 103.3% increase in estimated mortality rate to 2016, at which time period effects stabilised. Cohort effects revealed that individuals born between 1962 and 1982 (mainly Generation X) faced a higher-than-average mortality risk across all four causes, with risk decreasing in later generations. Despite different age profiles across the various causes of death, cohort effects suggest a single generation (Generation X: people born between 1962 and 1982) is predominantly experiencing the increase in meth/amphetamine-related mortality observed in Australia over the past 20 years. As Generation X ages, the risk of meth/amphetamine-related natural deaths, especially from cardiovascular disease, is likely to increase.

MDMA-related deaths in Australia 2000 to 2018

The incidence and cause of sudden cardiac death (SCD) in athletes is debated with hypertrophic cardiomyopathy often reported as the most common cause. A database of all National Collegiate Athletic Association deaths (2003-2013) was developed. Additional information and autopsy reports were obtained when possible. Cause of death was adjudicated by an expert panel. There were 4 242 519 athlete-years (AY) and 514 total student athlete deaths. Accidents were the most common cause of death (257, 50%, 1:16 508 AY) followed by medical causes (147, 29%, 1:28 861 AY). The most common medical cause of death was SCD (79, 15%, 1:53 703 AY). Males were at higher risk than females 1:37 790 AY versus 1:121 593 AY (incidence rate ratio, 3.2; 95% confidence interval, 1.9-5.5; P<0.00001), and black athletes were at higher risk than white athletes 1:21491 AY versus 1:68 354 AY (incidence rate ratio, 3.2; 95% confidence interval, 1.9-5.2; P<0.00001). The incidence of SCD in Division 1 male basketball athletes was 1:5200 AY. The most common findings at autopsy were autopsy-negative sudden unexplained death in 16 (25%), and definitive evidence for hypertrophic cardiomyopathy was seen in 5 (8%). Media reports identified more deaths in higher divisions (87%, 61%, and 44%), whereas the percentages from the internal database did not vary (87%, 83%, and 89%). Insurance claims identified only 11% of SCDs. The rate of SCD in National Collegiate Athletic Association athletes is high, with males, black athletes, and basketball players at substantially higher risk. The most common finding at autopsy is autopsy-negative sudden unexplained death. Media reports are more likely to capture high-profile deaths, and insurance claims are not a reliable method for case identification.